There are countless factors that can lead to your death.
As senior coroner,
I deal with nearly 4,500 fatalities a year.
LESLEY SHARP: The coroner can make any inquiries necessary
to find a cause of death.
The police act on behalf of the coroner.
If the coroner asks, then we do it.
We need to be alert to the fact that there could be
something more sinister in this.
With unprecedented access,
we follow the coroner's full investigation.
It does make you realise how fragile life is.
Let's start and just work our way up.
Forensic medicine is all about being very suspicious.
From the moment of arrival in the mortuary
to the final conclusion of the inquest.
All rise.
I'm sorry that you're attending court under these circumstances,
and I appreciate that the evidence
that you will hear today may be distressing.
I never thought I'd ever find myself in a coroner's court.
Shouldn't have to organise a funeral for your children.
If you die here, if it's violent, unnatural,
or of an unknown cause, it's my job to find out how.
I saw a police van outside the house,
and I just assumed it was one of the neighbours.
Ancl it was only when I came up the path
I saw the police person sat in my house,
and my heart sank.
I just knew...
I just knew what they were gonna say.
SH E EXHALES
Ancl I sat down, and she just said, "We've come about Sarah."
SHE SOBS
LINE RINGING
We've received a referral from Lancashire Police
in relation to a 39-year-old female called Sarah Kelly.
Sarah was a resident in temporary accommodation in Blackburn.
At the time of her death,
she'd only been there for a couple of days.
MACHINE WHIRRING
I understand she'd been doing some karaoke
with some of the other residents.
A little bit later on in the day,
Sarah's mentioned to the security guard
that she was gonna have a bath.
Now, the following morning, one of the maintenance staff
described the room as being full of steam.
And sadly, they discovered Sarah's body unresponsive.
So, I've spoken to next of kin, which is Sarah's mum.
I've explained to her that I will be asking the coroner
to authorise a CT scan postmortem.
But also, we'll ask the coroner to authorise
for some blood samples to be taken for toxicology analysis as well.
There's a number of possibilities,
and we need to understand exactly what it was
that caused this to happen.
Because she was in the bath with hot water,
there's been quite a bit of deterioration
in the condition of the body.
Obviously, the heat will rapidly cause those decompositional changes.
The maintenance operative that finds her the morning after,
finds her around eight o'clock in the morning.
So that suggests that Sarah had been in the bathroom for 13 hours.
Obviously, unfortunately, we can't pinpoint
the exact time of her death.
But it gives some indication of how long she'd been there.
The day before Sarah passed away,
there's a comment from one of the staff.
Sarah had been out and returned home with a male friend.
Sarah had, apparently quite loudly,
commented and said, "Why do men think it's OK to hit women?"
So, the staff member has spoken to her and explained
that it's never OK for anybody to hit anybody.
And from what I can understand, the gentleman that Sarah was with
has whispered something to her.
So, I suppose it's a bit strange.
It raises some questions.
just doesn't seem... real.
Doesn't seem possible that she could just
get in the bath, then not get back out of it
and carry on living her life.
She was only 39.
But to go just suddenly,
and like that, it's just mind-boggling.
NARRATOR: At Royal Blackburn Hospital,
coroner's officers have been investigating the sudden
and unexpected death of Sarah Kelly.
Sarah Kelly is a 39-year-old lady,
and she's staying for a couple of clays in temporary accommodation.
She has gone to a karaoke evening,
she has then gone back to her room with some food
and said that she's going to take a bath.
She is then found the following morning
in a bath of scalding hot water,
and we don't know why she's cited.
Witness statements from Sarah's case
have been taken and provided to the coroner.
LINE RINGING
Good afternoon, coroner's office, Chloe speaking.
Hello, Chloe, it's James Adeley.
'I've just been looking through Sarah Kelly's file.'
There's a number of comments in there about men hitting women,
and I would be grateful if we could just ask the police
to have a look at the case
and see whether or not there is any third-party involvement.
Yeah, of course. I'll get in touch with them today.
Before any medical examinations can be authorised by the coroner,
third-party involvement in Sarah's death
must be investigated by the police.
So, I was made aware of an incident in Blackburn
where there was a female
who had been discovered deceased in the bath.
As I arrive on scene, I enter the landing where the bathroom is.
Ancl on that landing, I can immediately see
that there's a CCTV camera.
There are several bedrooms,
and people are still free to come and go from their bedrooms.
So, instantly, what you're looking at is
locking down that bathroom so that nobody else goes in.
Preserve their dignity.
If there is to be a crime established,
don't compromise any scene.
There was no other place you could go from that bathroom,
no other way in, no other way out.
This is the window that opens out to about four inches
and then it shuts on a safety catch,
so it's not possible for a grown person to get through.
Ancl that had to be a consideration
because this is a ground floor bathroom.
So, I want to see when Sarah entered that bathroom.
Did she enter it alone?
Did she ever come out?
Did anybody else ever go in
prior to her being discovered the next morning?
Because it's hours and hours,
we've got to watch it to be sure that nobody's gone in.
Our Sarah was always the funny one.
She'd find the funniness in any situation.
Even when it was inappropriate, she'd laugh.
just full of life and full of fun,
that was the healthy, happy Sarah that we knew and loved, really.
She liked mother-henning people.
I think that's why she ended up liking the care sector
kind of in her job.
Making sure that people were all right
and doing the best for people.
Ancl people saw that's what she did.
She was one of twins.
Kind of a leader in some ways,
in the naughtiness.
They'd pretend to be each other all the time.
People would see Leanne and think it was Sarah.
They had the same form tutor right through high school
and he never knew which one was which,
he couldn't tell the difference between them.
Even though they were totally different people
with totally different personalities.
That's the... that's the strange bit cos I've lost a daughter,
but she's lost a twin who she spent all her life with.
It's her life, isn't it, that's just...
...that's just gone.
SH E EXHALES
So it's important to find out exactly what's happened.
In the early hours of the morning,
police have been called to gain access to a property in Burnley.
A man has been found deceased inside.
He has been transported to the mortuary
at Royal Blackburn Hospital.
We've had a referral from Lancashire Police.
They've attended a death, unfortunately, in Burnley.
And from what's been reported,
a neighbour of this gentleman
has contacted Lancashire Police with concerns for his safety.
They haven't seen him for around two to three weeks.
They've also reported that they've seen sort of some flies
on his windows.
So, the police officers have attended, forced entry to the flat,
and sadly, found him deceased in the living room.
It does appear that he probably has been there for some time,
and the process of decomposition has started.
We don't actually have any details of any next of kin
at the moment either.
And we will need to do some further inquiries
into formal identification for him.
So, the coroner's authorised a CT scan postmortem,
which will take place at Royal Preston Hospital.
But first, an external examination must take place.
I understand from the information we'd received from the coroner
that he's gonna be in quite a poor state of decomposition.
Ancl that's clearly the case.
The skin's dried out and become quite leathery.
Ancl so that gives him a sort of mummified appearance.
Cut the clothing away.
There are a number of aspects in this job
that people can find unpleasant.
Sometimes, the physical side of things, what people...
you see and you smell during the job.
Ancl also, sometimes, in certain cases,
the emotional element to it as well.
The physical side of things
is something that have never bothered me very much.
It's sometimes the background,
the stories, sometimes, that can have an emotional impact,
which is more... has more an effect on me.
There's nothing here to indicate what might have happened to him,
so at the moment, his cause of death is unknown.
So, what I'll do now is
I'll get him ready to send to Preston for his CT scan.
That's important because they can look inside
and see all the things that I can't see on the outside,
and then hopefully will establish a cause of death.
Hello? Hi, it is him.
A private ambulance has arrived to transport the man
to Royal Preston Hospital for his postmortem CT scan.
OK, thank you very much. OK, thank you.
I will be seeing you later.
They make this journey multiple times a day.
There's not many people do what we do.
We specialise in just doing this,
to move people between the various different hospitals
on a daily basis.
Ancl there's a lot of job satisfaction
in knowing that you've helped someone.
Ancl the fact that they were treated with dignity and respect.
We use unmarked vehicles
and we operate out of the public eye
because in general day-to-day life, as you're travelling,
people don't want to be reminded of their own mortality.
The coroner and the police are working on the investigation
into the death of 39-year-old Sarah Kelly.
Sarah returns to the hostel in the early evening, and she's upset.
She's making comments that men should not hit women.
With this, we need the police to investigate
whether she has been the victim of assault,
whether there is third party,
whether this might have caused her to lose consciousness.
Those are the types of questions we're looking at.
This is the doorway to the landing.
So, once you get through here with your key fob,
Sarah's bedroom is room number one, and that is directly here.
Ancl then this is the communal bathroom
and this where Sarah was discovered.
On this landing, you've got six bedrooms,
so there's another five residents potentially on this landing.
Between the time of her going in,
nobody else has entered that bathroom till she was discovered.
I'm as content as I can be
that there is no evidence of any third-party involvement,
there's no evidence of any foul play for the death of Sarah Kelly.
With the police having ruled out any third-party involvement
or recent assault connected to Sarah's case,
the coroner must try and establish a cause of death.
There's nothing obvious that stands out.
So it's just a case of taking a careful look
and making sure you're not missing anything.
As well as an external examination,
Dr Adeley has ordered toxicology to be taken
to be sent for testing.
One of the challenges getting samples for toxicology
from a body that's started to deteriorate is the fluids
that you want to collect - the blood and vitreous and so on
can start to break down or be difficult to obtain.
But we'll see what we can get.
So, we have managed to get a sample of blood.
It's not a very large sample and it's not the best quality.
We've not been able to get samples of vitreous or urine -
toxicology, obviously, the better-quality samples
and the larger sample of blood
allows them to run a larger number of tests and get better results.
But, hopefully, they'll be able to use the sample we've got.
With the toxicology samples taken,
Sarah's postmortem CT scan
will take place at Royal Preston Hospital.
Because Sarah Kelly is found lying in the bath,
it's quite likely that she had got in the bath
when the water was not scolding hot.
When she was found, the water was still flowing,
and so the temperature in the bath
has increased gradually through the period of the night.
Ancl this may well affect the findings on scan.
She was always a party goer,
liked going out, having a drink, being social.
I think the time where the alarm bells were starting ringing
were COVID.
I'm not blaming COVID for anything, but I think it had an impact.
And I think it was the isolation
that's kind of tipped the scales, if you will.
And then it was easier to drink, there was more time in the day,
it filled up some of the gaps.
She wasn't herself.
She wasn't the happy-go-lucky self that she was.
She was much more withdrawn,
personality kind of shifted.
It's not long at all, is it, to go downhill so fast?
It just seems impossible.
You look back and you think,
"Well, could I have done anything differently?"
Tried the softly-softly approach, you know,
"You really need some help."
We'd done the screaming and ranting and shouting.
And different family members have done the same.
And then she was pregnant,
and obviously, nobody could go with her
to all the appointments and things.
I'd spoke to her and asked her to go to the doctors
and see whether there was some depression
after having the little one.
In that moment, "Yeah, yeah, I'll get help, yeah, I'll be all right."
But then somehow couldn't find the strength to follow that through.
Sarah's postmortem CT scan must now be reviewed by a radiologist.
Submerged in a bath containing very hot water.
So hot that they couldn't even take the plug out.
We can see some fluid in the lower airways,
in the trachea and the main bronchi.
That can be seen in cases of drowning.
It's not specific, but it's something to take note of.
Sometimes, in cases of drowning, we will see fluid levels
and a fluid dissension of the stomach and the bowel,
with patients having swallowed a lot of fluid
into the gastrointestinal tract.
That's not present in the case.
So, that's a relevant negative finding in terms of drowning.
But again, it's not specific.
I think, for various reasons, the age of the patient,
there being no obvious underlying radiological abnormality,
this is a difficult one to say, based on the radiology,
with any degree of certainty
to be able give a cause of death, unfortunately.
So, I think the plan of action here,
I would suggest, is for a conventional postmortem.
It's not much different to when we got her ready for the external.
Now, if you go and look at the... the photograph from then.
LESLEY SHARP: At Royal Blackburn Hospital,
the investigation into Sarah Kelly's death continues.
An invasive postmortem has been ordered by the coroner.
Sarah Kelly is a 39-year-old lady
who has been found deceased in a bath in a hostel.
The difficulty here is that the radiologist says
that he can see some congestion,
some fluid in her lungs.
But he doesn't know whether this is consistent with drowning,
and we don't know, because the toxicology's not back yet,
as to whether she has slipped under the bath water
because she's intoxicated
or because she has had some natural event.
So, consequently, we definitely need to order an invasive postmortem.
Rigor mortis not present, nourishment average,
in brackets, weight 46kg, height 152cm full stop.
We need to have a very close look at the heart
so if we do think she's got an underlying cardiac condition
that has caused her to have this episode in the bath,
then we need to know about that.
There's wrinkling to the skin of the fingers and toes,
indicative of immersion in water, full stop.
We'll just have to see how it goes.
Whatever we deal with will depend on what we find.
We need to keep an open mind on this.
Here we are. Yeah.
This part of her memory box.
Remember playing with this when you were little? Yeah.
I've not seen that for years. Yeah.
SHE CHUCKLES
Ancl there's all the bits and pieces.
Lipsticks. Bright red.
Yeah, that was Sarah.
Yeah, slap it on, girl. Bright red lippy.
Kept a diary, her last diary.
Yeah. It's nice to see her handwriting.
I was six when Sarah was born, so my mum had her hands full.
But, yeah, I think we did all right.
SHE CHUCKLES
Ancl we was always close growing up.
It was always Sarah that I could count on.
If I needed anything, Sarah would be there, always.
Sarah's clad was an alcoholic.
He had his home brew, so he drank every night.
So I grew up with that.
When Sarah's clad died, she was 12 and I was 18.
I know she had Leanne,
and I think the two of them together
did get each other through a lot of things.
But I think it was difficult for their age.
I know in later years, it did affect them.
I wasn't expecting to hear that Sarah...
was that bad with her drink.
If my mum couldn't get through to Sarah,
then I don't think anybody would have
because you would have thought she'd have listened to my mum.
There must be something causes so much hurt and pain,
that the only way she could cope with was to drink.
just think, that's all that's left.
SHE SNIFFS
Yeah. It doesn't seem right, does it?
A postmortem CT scan has been ordered
for the man who was found badly decomposed in his house.
Coroner's officers continue to search for a next of kin.
In our modern societies,
particularly in larger population centres,
you can vanish through the cracks in society.
You can die without anybody knowing that you've died
and without your relatives being aware.
It's just the way we live now.
So, straight off from the scans, as they're going through,
we can see he is in quite a state of decomposition.
So, I believe he hadn't been seen for two to three weeks,
so it's gonna have at least been that long.
Obviously, we have had some quite warm weather as well,
which can sometimes cause decomposition to speed up.
There are occasions where you have people
who have decomposed to such an extent
that their organs may be missing.
Which makes coming up with a cause of death extremely difficult.
If you are then instructing for a postmortem by using a CT scan,
what you are looking for there is,
is there any obvious cause of death that may be on there?
They may have had a haemorrhage and there may be a collection of blood.
But even that may have disappeared.
What you're also looking for is an absence of signs of trauma,
that there's no broken bones,
there's nothing that you wouldn't expect.
But quite often, you end up with a situation
whereby the radiologist will simply say,
"There is nothing on the CT scan."
So you then come down to a natural cause of death
that is unascertained.
Consultant radiologistjim Simpson
is reviewing the man's postmortem CT scan.
We don't have a proper medical history.
Neighbour mentions that he may have suffered
with a heart condition -
that's helpful to a degree,
but it's not, you know, a heart condition
is a very general term, it doesn't give us specifics there.
First of all, we look through the head -
obvious from the start here
that there's a significant amount of decomposition.
We're seeing a large black area at the front of the skull vault,
and this is effectively air or gas that shouldn't be there.
And we can see gas bubbles within the brain tissue -
clearly, it's partially liquified and decomposing.
We can look at bone detail,
so the skull vault looks to be intact,
there's no evidence of skull fractures.
Looking through the chest here and the lung sac here,
they're completely collapsed and decomposed.
Then we look at the heart.
The heart is not enlarged,
I think we can safely say this heart is within normal size limits.
We have to accept the diagnostic quality's less than perfect
because of the decomposition.
Now, it may be that the coroner's team feel
that they need further information,
and they may consider an invasive postmortem.
The CT scan report has come back to us.
Unfortunately, the radiologist has commented
to say that due to the advanced stage of decomposition,
they are unable to provide a cause of death.
So, the coroner has authorised for an invasive postmortem,
which will be carried out by Dr Sis-sons, the pathologist,
who will hopefully be able to clarify further.
Dr Mark Sissons is also the pathologist
in the case of 39-year-old Sarah Kelly,
and he is continuing her invasive postmortem.
The liver is a very pale-yellow colour,
and this indicates a build-up of fat
caused by excess alcohol intake.
There's other causes for it as well.
So, fatty liver and alcohol
is an indication of possible sudden cardiac death,
related to alcohol abuse.
I would not have said she was an addictive natured person at all.
Maybe I just didn't see it, maybe I'm just Mum
and I don't see it and I just look for the best.
It was a bank holiday weekend -
she'd had a weekend of drinking and carrying on.
Ancl then there was an incident,
so she was brought back here by the police, very drunk.
Ancl at that point, I just thought,
"I've had enough, really, she needs to leave."
So, I just said to her, "You've got till seven o'clock tonight
"and I just want you to take what you need and just go, please."
So that we can start afresh.
Ancl I just asked her to leave her son here,
just for his safety,
because I didn't know where she was going.
It's not easy telling your child to go
because that's in the best interest for both parties
at that point in time.
I saw Sarah a week before she passed.
I'd met her with her son, so we'd gone for contact,
and she was so much better that clay
than she'd been in the previous weeks that we'd seen her,
so it wasn't like everything stopped,
there was still a relationship there.
Her lungs are distended and full of fluid.
I think I'm fairly confident at this stage
that this lady has drowned.
What I'm not sure about at the moment
is why this has happened.
We need to get the toxicology back to see what's going on there,
and we need to look at the histology of the heart,
ie, look at the heart down a microscope.
We just need to get all the results back
and then piece together an explanation of what's happened.
With all examinations on Sarah completed,
she can be released back to her family for her funeral.
In some ways, I thought I'd already grieved the girl that I'd lost,
from the happy, healthy Sarah that everybody knew
to the girl that she became when she had to leave and go into a hostel.
But this, this is a different level, it's just...
I walk into town and think, "Oh, she'll be in such a place,"
or, "I'll see her in such a place."
Ancl then you see people who vaguely, vaguely look like her
and I'll think, "Oh, she's there!" But she's not.
She's not there.
It's important that we, for her, that we find out her real story,
what really happened to her.
The coroner's office must update Sarah's family
on the results from the invasive postmortem and toxicology.
LINE RINGING
'Hello?'
Hi, Christine, it's Chloe from the coroner's office.
'So, I've got a bit of an update for you...'
OK. '..In relation to Sarah's heart.'
There wasn't any evidence of any significant disease
or anything of that kind.
'Right, that's good.'
In terms of what they have found,
so, primarily, that is coming from the toxicology,
mainly what they've found is quite a high level of ethanol,
so that's alcohol. Yeah.
'The legal driving limit with alcohol in the blood
'is 80mg per decilitre.'
The alcohol level found in Sarah's blood was roughly 360.
Yeah.
It's a shock, isn't it?
SHE SOBS Yeah.
'Yeah.'
Given the results, the coroner has authorised an inquest.
LESLEY SHARP: It's the day of 39-year-old Sarah's Kelly's inquest.
With this, I don't want the inquest to simply portray this lady
as somebody who died of alcohol issues. Yeah.
She had a life outside this,
and what's happened to her could happen to any of us.
Nervous, anxious.
SHE SIGHS
A bit worried about what I might hear.
I never thought I'd ever find myself in a coroner's court.
Morning. Morning.
My name's Chloe, I'm the coroner's officer.
So, we have three witnesses with us today.
We've got the detective inspector from Lancashire Police,
the security guard, who's statement you've seen,
and we've also got the pathologist. Yeah.
The alcohol is 360mg.
Now, it is very high for you or me, but in the hardened drinkers,
some people can function at that level.
The reflex when you inhale water into your airways is very powerful.
It then becomes a question, why does she slide under the water
and not come back up again?
Which, I must admit, troubled me from the beginning of this case.
Absolutely, absolutely.
All rise.
To Sarah Kelly's family and friends,
I'm very sorry that you're attending court under these circumstances.
The main findings were in the lungs,
where there was a large amount of fluid present.
Toxicology taken showed a high blood alcohol level,
four and a half times over the legal driving maximum.
I believe she's become drowsy, fallen asleep
and become deeply unconscious
so that when she's actually submerged in the water,
she can't respond and has drowned.
I find it really difficult or struggle to understand
how she didn't attempt to cough and wake herself.
It might be that her blood alcohol was still going up
when she was witnessed walking around
ten minutes before entering the bathroom.
And it could have continued to rise whilst bathing
to a level much higher than was present
when she was able to function earlier.
We can't prove this as we haven't got a urine alcohol measurement,
which would have given an indication
as to whether the blood alcohol was going up
or coming down prior to death.
That's my only possible suggestion.
I propose to accept Dr Sissons' medical cause of death,
which is that of drowning and alcohol intoxication.
I hope it's of some consolation that Sarah's period of suffering,
if she had any, would have been extremely short.
Sarah Kelly is somebody whose life has fallen apart very quickly.
In two and a half years, she's gone from having a house
and having a job to living in a hostel.
This shows you just how fast addiction to various substances
can destroy your life.
Ancl it's there but for the grace of whoever you believe in,
we all can go.
There's part of me thinking, well, at least we know.
I think it's helped knowing that they've been very thorough,
they have been really thorough, and that's a blessing,
to know that there'd been no stone left unturned.
Ancl I do appreciate that.
just to remember her, that bubbly girl
that would get up and sing
and yeah, just let it go now, let her be at peace.
In the case of the decomposed man, no cause of death has been found.
The coroner has ordered an invasive postmortem.
Meanwhile, efforts to find any family continue.
We do deal with a lot of cases like this,
where we have individuals that live alone,
maybe don't have much contact with family or neighbours
or other people,
and do appear to have been there for a little while.
It's quite upsetting because, you know,
there's potentially somebody out there
that's wanting to know what's happened to their loved one,
to their relative.
The body is in a very severely advanced stage of decomposition.
Extensive soft tissue loss here, full stop.
The organs are surprisingly quite well preserved.
When we have a decomposed body,
we'll try our best to find a cause of death,
and the thing we can normally do quite well
is we can examine the heart.
The coronary arteries,
they're normally quite well preserved
compared with other tissues.
There's a lot scarring, I can feel it when I cut into it...
It looks scarred, doesn't it? Yeah.
He has got a scarred heart,
almost completely blocked main coronary artery.
Which is fully consistent with a sudden cardiac death.
I haven't found any other pathology to explain his death.
This gentleman has no evidence of having had a heart attack,
but he does have scarring,
scar tissue within the wall of his heart,
indicating that he's been suffering from coronary artery disease,
an imparted blood supply to the heart.
This is a natural cause of death,
which means there's no inquest, we close our investigation.
Ancl as we have found a distant relative,
the body can now be released for funeral.
The man's relatives are happy for his story to be told,
but wish for him to remain anonymous.
Any sudden, unexpected death is extremely sad.
In cases where he's passed away at home,
there was nobody with him
and there isn't really any family to keep up to date.
And it's extremely sad,
but we still do the same investigations
we would with anybody else
to try and understand what has caused their death.
Without the coroner's office finding these causes of death,
people would be left with questions,
people would be left not being able to go ahead with funerals.
It's exceptionally vital.
All she'd wanted was children, being a mum.
Christine is helping to bring up Sarah's son.
Without him, I think I might have struggled to adapt
and get through a bit more.
He's got her laugh, he's got her smile,
and it's nice that we've got that, we've got that to hold onto.
Ancl he's such a lovely little boy, she's left a gift, really, with us.
Ancl when he's older, yeah, he'll be able to see exactly what happened,
but we'll be able to show him all the things
in the memory boxes that we've put together for him,
all things and show him what his mum was like,
that she was a happy, healthy girl, and she just loved life.
Ancl that's how we want him to remember her, really,
and to see her.
Oh, going to get you!
Going to get you! They're going to get you!
'Yeah, so, it's a few steps forward, a few steps back,
'but we will get there, we will get there.'
We've got a little man to focus on, we'll get there.
Ancl we'll remember her well.
Quite peculiar looking injuries.
There was no phone, there was no wallet on him
to give us any indication who he is.
You're walking into court,
but no idea of which way the case is going to develop.
We don't know whether she's done an intentional overdose or not.